Hi-tech camera equipment has revolutionised dermatology treatment for patients in Bridgend and Neath Port Talbot. Dr Alun Evans, a consultant dermatologist, explains why he set up the scheme to give GPs cameras

SKIN conditions account for about a fifth of a GP’s workload. Many of these patients can be dealt with in the practice, but a significant number end up being referred to hospital for a specialist opinion.

More than 6,000 new patients are seen in the Princess of Wales and Neath Port Talbot hospitals each year.

However, there is a national shortage of dermatologists and a number of posts remain unfilled, particularly in rural areas.

This is against a background of increasing levels of skin disease – especially skin cancer – and a higher demand for services.

There are also an increasing number of successful interventions which require specialist input, usually in a hospital setting.

Over recent years, this has led to long waits for patients to get a second opinion.

Currently the normal procedure is for a GP to write a referral letter to the hospital, which is then triaged by a consultant. For most specialities this is perfectly adequate, but dermatology is very visual and the current triage process relies on interpreting someone else’s written description of the clinical signs.

This can lead to inaccurate prioritising, mainly resulting in patients being given unnecessarily urgent appointments, which wastes resources.

Of more concern, however, are the (thankfully rarer) cases where patients have to wait too long for their appointment as they have mistakenly been given a routine appointment.

Under a new system, GPs take a high-quality Instamatic clinical photograph of the patient’s skin complaint in the surgery and send it to the specialist, along with their written referral.

This is subject to the patient’s consent – sometimes the patient or GP may decide that sending a picture is not appropriate.

This scheme makes our referral system much safer for patients, helping to avoid potentially dangerous errors.

The cameras themselves are not the Polaroid Instamatics marketed for use on holiday in the 1970s – they are Polaroid Macro 5 series which cost around £700, with each photo costing a further 80p. Despite their unusual appearance, they are hi-tech pieces of photographic equipment often used by the police, scientists and forensic teams for producing high-quality close-up images.

They have the advantage of being very simple to use, requiring minimal training to obtain excellent clinical images every time.

The photos have been invaluable in improving the triage process and spotting severe disease or skin cancers.

There has also been an interesting by-product of this system, in that some of the photographs are of such good quality that a consultant dermatologist can make a clinical decision based on the photograph alone, without actually seeing the patient.

We call this a virtual consultation and it not only speeds up a patient’s treatment but saves them a trip to the hospital and releases an outpatient appointment which can be used by someone else.

Because early detection and treatment are so important in skin cancer, these cameras might even be life-saving.

Patients who do not need to be seen are often sent directly for minor surgery or other treatments, or their GP is given advice on how to manage them within primary care.

When the project was introduced at Neath Port Talbot Hospital doctors found that 60% of patients who were referred with a photograph could avoid their first outpatient visit.

So far more than 2,000 first appointments have been saved and if we can dramatically improve the efficiency of dermatology services we hope to be able to achieve our goal of dramatically reducing waiting lists.

The project was funded as a joint venture between the Bridgend and Neath Port Talbot local health boards and the hospitals and is subjected to regular performance review.

Our aim is to deliver increased efficiency and capacity without any effect on the quality of the service. So far there has not been a single adverse event or complaint from a GP or a patient.

Using photographs to deal with difficult cases to avoid long journeys from rural areas is not a new concept.

Teledermatology has been around in various guises for many years. However the screening approach employed by these dermatologists, whereby every patient has a photograph sent with their referral, is unique to South Wales. Dr Kevin Hunt, a GP in Port Talbot, said: “The introduction of the cameras in primary care has been the single most important change in the local dermatology service in the 25 years I have been in practice.”

The scheme won the Bro Morgannwg NHS Trust chief executive’s innovation award in December 2007 and the prize money is being used to set up a health psychology post at the Princess of Wales Hospital to provide counselling and support to those affected by their skin disease.

Dr Alun Evans is a consultant dermatologist at the Princess of Wales Hospital, in Bridgend, and Vale Healthcare, in Cardiff Bay. For more information visit www.southwalesdermatologist.co.uk

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